Identification and risk-factor analysis for individuals at high risk for keratoconus via machine learning and logistic regression

Abstract

Purpose To evaluate keratoconus (KC) risk factors and to develop a machine-learning (ML) model for KC and myopia classification. Methods In this retrospective single-center cross-sectional study, demographic and lifestyle data from patients with KC and individuals from a preoperative refractive surgery clinic were collected from January 20, 2024, to December 1, 2024. Univariable and multivariable regression analyses were used to identify key risk factors. Additionally, random forest (RF)-recursive feature elimination (RFE), extreme gradient boosting (XGBoost)-RFE, and univariable logistic regression were applied to select factors for ML models. Seven ML models were developed for a lifestyle-based classification system, with the performance being validated through discrimination and calibration, and interpretability being improved using SHapley Additive exPlanations (SHAP). Results Analysis of 711 patients (mean [standard deviation] age, 26.6 [7.1] years; 439 males [61.7%]) revealed 275 with KC. Multivariable regression analysis identified seven risk factors for KC, including male sex, higher body-mass index (BMI), lower education level, more distant childhood residence, allergic conjunctivitis, and increased eye-rubbing intensity and frequency. After feature selection of 24 variables, the neural-network model demonstrated the highest performance (area under the receiver operating characteristic curve [AUROC] = 0.79), followed by RF (AUROC = 0.77) and XGBoost (AUROC = 0.76). SHAP analysis consistently highlighted eye-rubbing intensity, sex, BMI, and childhood residence among the top 10 factors across the top three models, which were also confirmed by univariable logistic regression. Conclusion ML models can distinguish high-risk KC groups based on clinical risk factors, facilitating risk stratification and early lifestyle interventions.